Healthcare

Fig.ME.S.HC.01; Authors Own, 'Healthcare Sketch'

RESEARCH JUSTIFICATION

Understanding the structure and trends of Scotland’s National Health Service is crucial to ensure equitable healthcare. The system currently faces increasing pressures from workforce shortages and an aging population which increase the demand for services.

What are the main challenges facing healthcare in Scotland?

Scotland Healthcare Structure

NHS Structure

The NHS (National Health Service) is a UK wide institution funded by taxpayers that provides free healthcare to all UK citizens. In 1999, responsibility for healthcare was devolved from the UK Government to the individual nations of the UK. Since then, the Scottish government has held full authority over healthcare policy and related decision making in Scotland (Kelly Shuttleworth, Elspeth Nicholson, Institute for Government “Devolution of NHS”, 2020).

NHS Scotland operates as a hybrid system, with most authority centralised within the Scottish Parliament, which sets policy direction and allocates funding. These decisions are then implemented by regional health boards, which operate with limited autonomy (NHS, “About NHS Scotland”, 2025).

“The delivery of NHS services must be reformed for Scotland’s health service to remain affordable and sustainable”

“The mix of local, regional, and national patterns across Scotland makes decision making and accountability difficult”

- Stephen Boyle (Healthandcare.scot “NHS Governance must be strengthened, says watchdog”, 2025)

Fig.ME.S.HC.02; Authors Own, 'NHS Structure'

There are 14 Regional Health Boards across Scotland, each responsible for planning and delivery healthcare services within its area. These boards receive legislation and funding from the Scottish Government and have discretion over how resources are used, providing this aligns with national priorities. They are supported by national boards that deliver specialist services and expertise. Individual hospitals and practices operate under the guidance and funding of their regional boards, delivering healthcare directly to local communities (NHS, NHS “About NHS Scotland”, 2025).

This audit shows that although individual regional health boards operate independently in theory, in practice their scope is limited by the systems top heavy structure.

“The planning of healthcare in Scotland is becoming more complex and the Scottish government needs to ensure lines of accountability and decision-making are clear”

- Stephen Boyle (Healthandcare.scot “NHS Governance must be strengthened, says watchdog”, 2025)

Case Study - The Swedish Model

Sweden’s healthcare model is an example of a decentralised system, with each region operating with a high degree of autonomy. Funding, structure and priorities are adapted to local needs, which is important in a country where population density ranges from approximately 367 people per square kilometre to fewer than 5 people per square kilometre in Vasterbotten (ExpoMedics, "How Healthcare in Sweden Works", 2021) (Official Statistics of Sweden, "Population density per sq.km, population and land area by region and sex. Year 1991 - 2024). This regional flexibility is particularly relevant to countries such as Scotland, where geography and population distribution also vary widely.

The national government plays a limited role, setting broad guidelines and national priorities, while the 21 regional councils hold most decision making authority (ExpoMedics, 2021). These councils fund and deliver healthcare services, raising most revenue through local taxation, with central government grants supporting less affluent areas. Although Sweden charges small fees for medical care, they are capped at SEK 1,400, approximately £111 per year. Regional boards diagnose complex conditions and, when required, refer patients to one of Sweden’s seven regional university hospitals. Alongside this, the country’s 290 local municipalities provide an additional layer of care by managing elderly services and social support (ExpoMedics, 2021).

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Fig.ME.S.HC.06; Authors Own, 'Swedish Virtual Health Hubs'

In remote areas of rural Sweden, travel to the nearest hospital can take up to four hours by car. To address this, regional healthcare systems increasingly rely on digital technologies to maintain access to care. Tools that allow professionals to “evaluate lab results, electro diagrams and even conduct emergency appointments remotely” help reduce unnecessary hospital visits (World Health Organization, "How digital health became the norm in Sweden's remote north: Sofie's perspective", 2023).

Dr Sophie Lyhammar, who works between Stockholm and Storuman, one of Sweden’s most remote regions where resident doctors are uncommon, provides constant care through remote video consultations. During appointments, she connects a virtual health room where a nurse supports the patient and carries out procedures such as electro diagrams, which Dr Lyhammar can review in real time (World Health Organisation, "How digital health became the norm in Sweden's remote north: Sofie's perspective", 2023).

This approach is now used to manage a wide range of conditions, ensuring patients travel to hospital only when necessary. It is clear how a similar approach could be integrated within Scotlands NHS, particularly in areas as remote as the Highlands and Islands, with the main challenge being digital connectivity.

Fig.ME.S.HC.07; Authors Own, 'Swedish Healthcare System', based on, (ExpoMedics, "How Healthcare in Sweden Workd", 2021)

"To me it doesn't matter if the doctor is there physically or if we communicate via a screen. The most important thing for me is that it’s the same health professional who knows me, my illness and of course my treatment"

Anonymous Patient (Healthcare at a distance, accessed 2025)

NHS Reform

In 2025, NHS Scotland introduced two major strategic plans, the NHS Scotland Operational Improvement Plan and Scotland's Population Health Framework, to shift the system from a reactive model to one focused on prevention.

This responds to intensifying pressures, including poor population health, with two thirds of people overweight, an aging population, workforce shortages and a rising demand for services. Together, these factors have weakened the system’s ability to provide equitable access to care. The new strategies aim to secure the long-term sustainability of public services, reduce health inequalities and make better use of digital innovation. As highlighted after the COVID-19 pandemic, “our resilience to future health threats is dependent on reducing health inequalities and creating environments where it is easier to live healthier lives” (NHS Scotland, NHS Scotland operational improvement plan, 2025) (NHS Scotland, Scotland's Population Health Framework, 2025).

"Health inequalities are mostly shaped by the social determinants of health: the conditions in which people are born, grow, live, work and age, and takes action to improve health and reduce health inequalities"

- Stephen Boyle (Healthandcare.scot “NHS Governance must be strengthened, says watchdog”, 2025)

New Reform identifies that the most deprived areas face disproportionate ill-health, with “higher rates of illness and shorter life expectancy – compared to those in more affluent areas” (NHS Scotland, NHS Scotland operational improvement plan, 2025).

Reform is expected to be delivered primarily through local Health and Social Care Partnerships (HSCP), which operate beneath regional boards and are supported by the third sector. Established in 2016, HSCPs aim to integrate health and social care and are well positioned to respond to local needs. (NHS Scotland operational improvement plan - Scotland's Population Health Framework).

However, their capacity to deliver meaningful change is constrained by the NHS’s centralised structure. This was highlighted by Dr Alison Clement, Clinical Director of Angus HSCP, who noted challenges in getting all parties to work together and make effective use of resources. She referred specifically to difficulties coordinating with NHS Tayside and primary care services (Dr Alison Clement, Interview with Ryan Smith on 14.11.2025).

Fig.ME.S.HC.05; Authors Own, 'Levels of Prevention', based on, (NHS Scotland, Scotlands Population Health Framework)

NHS Change 2 out of 3 outside healthy weight.png

Fig.ME.S.HC.03; Authors, 'Overweight Population' ,based on, (NHS Scotland, Scotlands Population Health Framework)

Fig.ME.S.HC.04; Authors Own, 'Drivers of Scottish NHS Reform, (NHS Scotland, Scotlands Population Health Framework)

Challenges and Potential Solutions

Fig,ME.S.HC.09; Authors Own, 'Increased Pressure on Primary Care Services Scotland', based on, (British Medical Association, "The sustainability crisis in GPs currently 'seeking work' in Scotland alone", 2025)

30 min travel time A&E and MIU on white-01-01.png

Fig.ME.S.HC.08; Authors Own, 'Emergency Healthcare Departments, 30min travel time highlighted'

Strains on the NHS

The Scottish NHS is currently under significant strain, largely due to limited resources and the lasting impact of COVID-19. Since the start of the pandemic, the number of patients waiting for treatment has increased from 256,000 to 560,000 (Public Health Scotland NHS Waiting Times, BMA, 2025). This has had a substantial effect on access to care. While most people continue to rely on public healthcare, approximately 29% have turned to private healthcare since the pandemic, due to long waiting times. This shift increases inequality, as those in more deprived circumstances are less able to afford private care (Hayley Barnes, About a Third of Scots Have accessed Private Health Care For Someone In Their Household, 2025).

Almost half of GP practices in Scotland, 44.8%, describe their future as “precarious” or “unsustainable” due to “unimaginable” workloads.

Anonymous Patient (Healthcare at a distance, accessed 2025)

Pressure is particularly evident in primary care. This situation is driven by rising patient numbers alongside a fall in GP practices, from 1,000 in 2012 to 889 in 2024 (British Medical Association, “The sustainability crisis in GP practice in Scotland”, 2024). Financial pressures workforce shortages have contributed to this decline, prompting the Scottish Government’s GP recruitment campaign in 2022 (Scottish Government, “Launch of GP recruitment campaign”, 2022).

Despite these efforts, approximately 160 full time equivalent GPs remain unemployed. Funding these roles, the equivalent to 1% of the annual Scottish NHS budget, could deliver “approximately 700,000 additional appointments annually”, easing waiting times nationwide (Anna Colivicchi, 2025).

A resilient healthcare system should be able to respond to both low and high demand. However, years of cost saving have limited investment in resilience, leaving the Scottish NHS operating close to capacity. This has reduced its ability to absorb shocks, as demonstrated during the COVID-19 pandemic, when limited capacity led to shortages of staff and resources.

Thumbnail Sketch_NHS and COVID_Queues for Hospitals.png

Fig,ME.S.HC.10; Authors Own, 'Que Sketch'

Case Study - Project CAELUS

Care & Equity Logistics UAS Scotland, known as CAELUS, is a healthcare innovation project that uses drone technology to create a medical delivery network. The integration of drones aims to improve the efficient distribution of medical supplies across Scotland, addressing geographical challenges and workforce limitations.

In addition to transporting pharmaceuticals, the reduces delivery times for laboratory samples and blood, which can significantly improve diagnostic and consultation processes by enabling faster clinical decision making.

Following a series of successful trials, which concluded in June 2024, test flights across Scotland demonstrated the potential for drone technology to be integrated into Scotlands healthcare system (Innovate UK, CAELUS 2, accessed 2025).

Fig,ME.S.HC.11; Authors Own, 'Drone Sketch'

Fig,ME.S.HC.12; Authors Own, 'Drone Delivery Sketch'

'In one case, the journey between NHS Lothian and NHS Borders was reduced to 30 minutes, a journey that currently takes several hours by road.'

(BBC News “Drones fly NHS lab specimens in Scottish first”, 2024)

Women's Health Care

Women make up over half of Scotland's population, yet women's health continues to be seriously underfunded and under researched since the beginning of contemporary medicine. While issues like maternity care have been at the forefront of women's health research many other conditions like Endometriosis and PCOS have been overlooked to the point that older women now suffer the consequences of having never been diagnosed and have an increased risk of things like cancer as a result. Many women report their pain being dismissed when speaking to a medical professional which can be attributed to a wider issue of systemic disbelief of women and misogyny. (Nature Reviews Bioengineering "Funding research on women’s health.") (eClinicalMedicine (2024). "Gendered pain: a Call for Recognition and Health Equity.")

In many areas of rural Scotland, a major issue for women's health is a lack of safe places to give birth. For example, in the region of Caithness in North West Scotland, as many as 90% of pregnant women may need to travel up to 100 miles or more to reach Raigmore hospital in Inverness, or sometimes even all the way to Aberdeen, to give birth. This is due to a lack of specialised care and consultants in the local general hospital. (McKenzie, S. (2023). Call for review into Caithness women’s health services. BBC News.) (Bowey, J. BBc News. (2025). "Caithness campaigners welcome UN report on maternity services.")

With new advancements in medical technology being made within centralised urban contexts, integrating them into more decentralised systems with wider stretching reach seems to be the logical next step.

Fig,ME.S.HC.13; Author’s own, ‘Women’s healthcare infographic’ based on (“Why Nearly 80 Percent of Autoimmune Sufferers Are Female…”, Scientific American, 2021), (“Depressive disorder…”, WHO, 2025), (“Women are 50% more likely than men to...”, BHF, 2016), (“Menopause and bone loss”, Endocrine Society, 2022), (“Global average life…”, Our world in data, 2025), (“Menstruation cycle”, Britannica, 2025), (“Your antenatal appointments, NHS, 2023), (“Diagnostic Testing”, Circle health group, 2025), (“Your antenatal appointments, NHS, 2023), (“Data analytics in healthcare…”, Data Channel, 2025), (“Life Expectancy in Scotland”, National Records of Scotland, 2024), (“Average age of mothers at childbirth in the UK..”, Statista, 2025), (“Barriers in access to healthcare for women”, National Library of Medicine, 2021)